Adults: 5 to 20 mg P.O. (prompt-release tablets) two to three times daily. Or, 20 to 30 mg (oral solution) P.O. daily. Once maintenance dosage is determined, may switch to extended-release.

Children older than age 6: Initially, 5 mg P.O. (prompt-release tablets or oral solution) before breakfast and lunch; increase by 5 to 10 mg at weekly intervals, not to exceed 60 mg/day. Once maintenance dosage is determined, may switch to extended-release.

In all patients, Ritalin-SR or Metadate ER may be prescribed instead of prompt-release tablets when 8-hour dosage of those forms corresponds to titrated 8-hour dosage of prompt-release tablets.

Concerta-

Adults: If new to methylphenidate, initially 18 or 36 mg/day. Increase dosage by 18 mg/day at weekly intervals, not to exceed 72 mg/day. For patients currently using methylphenidate, dosing is based on current dosage regimen and clinical judgment.

Children ages 6 and older who haven't used methylphenidate previously: Initially, 18 mg P.O. once daily in morning; may be titrated weekly up to 54 mg/day

Children ages 6 and older using other methylphenidate forms: 18 mg P.O. once daily in morning if previous dosage was 5 mg two to three times daily, or 20 mg P.O. daily (sustained-release); 36 mg once daily in morning if previous dosage was 10 mg two to three times daily or 40 mg daily (sustained-release); or 54 mg once daily in morning if previous dosage was 15 mg two to three times daily or 60 mg once daily (sustained-release)

Metadate CD-

Children ages 6 and older: Initially, 20 mg once daily; may adjust in weekly increments of 10 to 20 mg, to a maximum of 60 mg/day taken in morning

☞ Don't give within 14 days of MAO inhibitor use.• To help prevent insomnia, give last daily dose of conventional tablets several hours before bedtime.• Discontinue drug periodically in children who have responded to therapy, to assess patient's condition. After withdrawal, improvement may be temporary or permanent.• Be aware that therapy shouldn't continue indefinitely.

Patient monitoring

• Monitor patient periodically for drug tolerance and psychological dependence.• Watch for adverse effects. Know that these usually can be controlled by adjusting schedule or dosage.• Monitor for contact sensitization (erythema accompanied by edema, papules, vesicles) that does not significantly improve within 48 hours or spreads beyond the patch site. Discontinue drug if this occurs.• Stay alert for tachycardia, abdominal pain, insomnia, anorexia, and weight loss (more common in children).• Consider periodic hematologic and liver function tests, especially during prolonged therapy.• Monitor blood pressure, especially in patients with history of hypertension.• Evaluate child's weight and growth patterns.• Assess child for tics, which may develop in 15% to 30% of children using drug.

Patient teaching

• Inform patient or parent that last daily dose should be taken several hours before bedtime to avoid insomnia.• Make sure patient or parent understands how drug should be taken.• Tell patient taking Concerta not to be concerned if tablet-like substance appears in stool.• Teach caregiver how to use patch and to make sure that skin is clean, dry, and free of cuts or irritation.• Tell caregiver not to allow child to use heat sources, such as heating pads or electric blankets, while wearing the patch.• Instruct caregiver to report redness accompanied by swelling or solid bumps or blisters on the skin that do not significantly improve within 48 hours or spread beyond the patch site.• Tell caregiver to replace the patch if it falls off, but total wear time for the day should remain 9 hours.• Advise patient or parent to report insomnia, palpitations, vomiting, fever, or rash.• Caution patient or parent that continual use may lead to psychological or physical dependence.• Instruct patient to avoid driving and other hazardous tasks until drug effects are known.• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.

methylphenidate hydrochloride

[-fen′idāt]

a central nervous system stimulant.

indications It is prescribed in the treatment of attention deficit/hyperactivity disorder in children and, more recently, adults and for narcolepsy in adults.

contraindications Glaucoma, severe anxiety, tension, mental depression, or known hypersensitivity to this drug prohibits its use. It is not given to children less than 6 years of age.

adverse effects Among the more serious adverse effects are nervousness, insomnia, and anorexia. Hypersensitivity reactions and tachycardia may occur.

methylphenidate hydrochloride

(mĕth″ĭl-fĕn′ĭ-dāt)

A drug that is chemically related to amphetamine. It is used in treating narcolepsy and attention deficit disorder.

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